Mental Illness in Children & Adolescents: Q&A with Dr. Aaron Krasner

Quick Facts: Mental Illness in Children & Adolescents

• 1 in 5 children, either currently or at some point during their life, have had a seriously debilitating mental disorder
• Most mental disorders begin by the age of 14, but often treatment isn’t sought until years later.
• Only 20 percent of children with mental disorders are identified and receive mental health services
• Suicide is the third leading cause of death in youth ages 15 to 24. More teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung disease combined.
• Approximately 50% of students age 14 and older who are living with a mental illness drop out of high school.

  What are the most common mental disorders among children and adolescents? Among young children (0-5), the most common mental illnesses include neurodevelopmental disorders such as Autism Spectrum Disorders, Attention Deficit/Hyperactivity Disorder, and externalizing disruptive behavior disorders. Among patients aged 6-12, the most common illness – by far – is anxiety with an estimated 20% of school age children meeting criteria for an anxiety disorder. With the onset of puberty, the most common disorders are mood and anxiety disorders, substance use disorders and psychotic illnesses. What signs should parents watch for that might indicate an underlying mental illness? Parents should be concerned about changes in behavior, appearance, friend groups, intensifying moodiness, withdrawal, anger, and academic/social difficulties.  Friends, family, and siblings will recognize these changes and the best advice for parents is to be keyed in to these messages and respond with validation and offering kids and adolescents a consultation with a qualified mental health professional. How have you seen lives change with proper treatment? Lives turn around, people get better, I see it every day.  In psychiatry, the road to recovery tends to be slower.  However, appropriate medical, psychosocial, and vocational interventions are effective across the spectrum of psychiatric diagnoses and children, adolescents, and adults are all able to turn what seems like an overwhelming problem into a life worth living.  I have nurtured patients from the depths of suicidal depression to very high functioning careers and academic achievements and as a practitioner this is quite gratifying. For me, personally, the most gratifying piece of my work is the slow but steady improvement I see in my patients and the slow and steady positive ripple effect that has on his or her social world. You have said there is a mental health crisis when it comes to children and adolescents. Can you describe this? Over the last fifty years, the field of psychiatry has increasingly come to appreciate that all of the biological and genetic vulnerabilities that underlie common psychiatric conditions are present pre, peri, and postnatally. The dynamic relationship between genes and environment during critical developmental years leaves a lasting impact as we age and mature into adults. Although this concept is understood, there is little funding for pediatric psychiatric research and stigmatization of childhood mental illness is still prominent.  Qualified child and adolescent psychiatrists and child and adolescent allied mental health providers are scarce. The workforce shortage in this specialty is astounding, especially since the fact is one in four children with documented, diagnosed mental illness receives any kind of treatment. Detecting these disorders early on leads to more positive outcomes. If there were a more robust child and adolescent mental health screening program that without judgment or bias gave patients an opportunity to receive the help and support they need, downstream effects on their lives and the lives of their loved ones would be much improved.